Performance Improvement 2004. Changes in Elderly Disability Rates and Implications for Health Care Utilization and Cost


This study was undertaken to better understand disability trends and the potential implications for acute health and long-term care use. Recent research has shown that functional disability among older Americans has decreased. There is also evidence that cognitive impairment and physical limitations, such as lifting 10 pounds, walking short distances, and climbing a flight of stairs, which may be precursors to functional disability, may have also declined in recent years. Four panels (1984, 1989, 1994 and 1999) of the National Long Term Care Survey were used to identify older Americans with a chronic disability (defined as a functional limitation lasting at least 3 months). Aggregate trends in disability were examined and decomposed by type of functional limitation, i.e., disability based exclusively on limitations in instrumental activities of daily living (IADLs) such as money management and meal preparation that are associated with the ability to maintain independence at home, and limitations in activities of daily living (ADLs) such as dressing and eating that indicate a higher level of disability or frailty. The major findings include: (1) the prevalence of chronic disability among the elderly declined significantly over the 15-year period, from 22.1 percent in 1984 to 19.7 percent in 1999, (2) the aggregate decline was mostly due to decreases in the percentage of elderly persons receiving help from someone for IADLs, (3) nearly all individual IADLs declined over the period, but the most dramatic change was a 3.7 percentage point drop in help with money management between 1984 and 1989 when Social Security direct deposit became the norm, (4) no individual ADLs significantly declined in prevalence over the period, and (5) the prevalence of institutional residence, the most costly form of long-term care, was about 5 percent of the elderly throughout the period.

PIC ID: 7554
Agency Sponsor: ASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Marton, William, 202-690-6443
Performer: Urban Institute, Washington, DC

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